Student and family reside in one of the areas listed in the General Requirements*

YesNo

Student and family are registered members of a Catholic parish in one of these areas*

YesNo

Student's Grade 4 first AND second trimester or first AND second quarter report cards show major subject grades to be all A/A*

YesNo

The student's Total Reading, Total Mathematics and Language scores are in the 94th percentile or above*

YesNo

IF THIS STUDENT IS AWARDED A KNOTT SCHOLARSHIP YOU WILL BE REQUIRED TO PROVIDE US A LETTER FROM THE PASTOR OF THE PARISH OF WHICH YOU ARE A REGISTERED MEMBER CONFIRMING REGISTRATION IN THIS PARISH. LIST BELOW THE PARISH OF WHICH YOU ARE A MEMBER. DO NOT SEND PASTOR'S LETTER WITH THIS APPLICATION. YOU WILL BE NOTIFIED IF THIS LETTER IS REQUIRED.

Student and family are members of the following Catholic Parish:*

Parish address:*

Student attends this school:*

PUBLIC SCHOOL STUDENTS ONLY

Student has been accepted to the following Parish School:*

A copy of the Parish School (where the child will attend) acceptance is attached*

YesNo

Parent/Guardian is submitting a Parent's Financial Statement:*

YesNo

If you select 'Yes', use the code number for the Marion Burk Knott Scholarship -- 4835 -- when completing the Parent's Financial Statementform.

Send in a sealed envelope labeled confidential, a copy of your 2015 (not 2016) Federal Income Tax return, including all schedules if used. Failure to do this will disqualify you from financial need consideration.

It is understood and agreed that scholarship application records are confidential and no information from the application, test scores or evaluation will be disclosed to anyone, including but not limited to applicants, parents, guardians or school personnel. All decisions are final.

I certify that all foregoing information is true, correct and complete. I further understand that falsification of any information provide to the Knott Scholarship Funds will disqualify the above named student from scholarship consideration.

The signature of both the Parent/Guardian and Student are required on the completed application.

When you have completed the form please fill in the Captcha Code field below with the characters shown, then click 'Submit'.